Provider Demographics
NPI:1588696165
Name:DRASKOVIC, NANCY MARIA (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARIA
Last Name:DRASKOVIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:MARIA
Other - Last Name:DRASKOVIC DOSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:#103
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-360-0111
Mailing Address - Fax:703-799-1126
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-360-0111
Practice Address - Fax:703-799-1126
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001347152W00000X
MDTA1621152W00000X
MDOP10000045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD747L21XXMedicare PIN
MDU83674Medicare UPIN
DC006466E22Medicare PIN